Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.

Salazar-Vizcaya, Luisa; Keiser, Olivia; Technau, Karl; Davies, Mary-Ann; Haas, Andreas D; Blaser, Nello; Cox, Vivian; Eley, Brian; Rabie, Helena; Moultrie, Harry; Giddy, Janet; Wood, Robin; Egger, Matthias; Estill, Janne (2014). Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study. AIDS, 28(16), pp. 2451-2460. Lippincott Williams & Wilkins 10.1097/QAD.0000000000000446

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OBJECTIVES Many paediatric antiretroviral therapy (ART) programmes in Southern Africa rely on CD4⁺ to monitor ART. We assessed the benefit of replacing CD4⁺ by viral load monitoring. DESIGN A mathematical modelling study. METHODS A simulation model of HIV progression over 5 years in children on ART, parameterized by data from seven South African cohorts. We simulated treatment programmes with 6-monthly CD4⁺ or 6- or 12-monthly viral load monitoring. We compared mortality, second-line ART use, immunological failure and time spent on failing ART. In further analyses, we varied the rate of virological failure, and assumed that the rate is higher with CD4⁺ than with viral load monitoring. RESULTS About 7% of children were predicted to die within 5 years, independent of the monitoring strategy. Compared with CD4⁺ monitoring, 12-monthly viral load monitoring reduced the 5-year risk of immunological failure from 1.6 to 1.0% and the mean time spent on failing ART from 6.6 to 3.6 months; 1% of children with CD4⁺ compared with 12% with viral load monitoring switched to second-line ART. Differences became larger when assuming higher rates of virological failure. When assuming higher virological failure rates with CD4⁺ than with viral load monitoring, up to 4.2% of children with CD4⁺ compared with 1.5% with viral load monitoring experienced immunological failure; the mean time spent on failing ART was 27.3 months with CD4⁺ monitoring and 6.0 months with viral load monitoring. Conclusion: Viral load monitoring did not affect 5-year mortality, but reduced time on failing ART, improved immunological response and increased switching to second-line ART.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Salazar, Luisa Paola; Keiser, Olivia; Haas, Andreas; Blaser, Nello; Egger, Matthias and Estill, Janne Anton Markus

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0269-9370

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

01 Apr 2015 10:23

Last Modified:

04 Nov 2019 10:52

Publisher DOI:

10.1097/QAD.0000000000000446

PubMed ID:

25392857

BORIS DOI:

10.7892/boris.65548

URI:

https://boris.unibe.ch/id/eprint/65548

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